风湿性二尖瓣狭窄伴心房纤颤球囊二尖瓣成形术后心房纤颤的…

报道９０例风湿性二尖瓣狭窄伴心房纤颤球囊二尖瓣成形术后复律治疗的结果。８９例患者在ＰＢＭＶ后２周内接受复律治疗，１５例服用奎尼丁后恢复窦性心律，７４例经体表电复律转为窦性心律。     

风湿性二尖瓣狭窄伴心房纤颤患者在经皮球囊二尖瓣成形术后的心房纤颤电复律治疗(附538例报告)

探讨风湿性二尖瓣狭窄伴心房纤颤（房颤）球囊二尖瓣成形术（PBMV）后房颤复律治疗的方法及复律后影响维持窦性心律的因素。方法：PBMV术后4～6周仍不能转复为窦性心律的房颤患者538例进行电复律治疗，转复后随诊3～6个月，动态观察房颤复发情况。结果：538例行体表电复律者，恢复窦性心律。     

风湿性二尖瓣狭窄伴心房颤动球囊二尖瓣成形术后复律治疗的临床评价

报道９０例风湿性二尖瓣狭窄伴心房颤动（简称二狭房颤）患者球囊二尖瓣成形术（ＰＢＭＶ）和复律治疗的结果，并与同期行ＰＢＭＶ的１６０例风湿性二尖瓣狭窄无房颤（窦性心律，简称二狭窦律）患者进行比较。结果表明临床上无血管栓塞并发症且经超声心动图检查无心房血栓的二狭房颤患者接受ＰＢＭＶ治疗与二狭窦律者一样具有良好的安全性和临床效果。８９例二狭房颤患者ＰＢＭＶ后经复律治疗转为窦性心律（其中１５例仅服用奎尼丁即可复律）。随访２３．５±１１．７月，２４例（２７％）复发。认为房颤持续时间长和左房明显扩大可能是房颤复发的影响因素；ＰＢ－ＭＶ的效果可能是房颤复律后远期疗效的影响因素     

二尖瓣狭窄球囊成形术后心房颤动的复律治疗及其影响因素

为评价二尖瓣球囊成形术（ＰＢＭＶ）后心房颤动的复律疗效及维持窦性心律的影响因素，对３０例风湿性心脏病二尖瓣狭窄伴心房颤动（简称二狭房颤）的患者在ＰＢＭＶ后１～２周进行复律治疗。结果显示：ＰＢＭＶ后近期复律治疗房颤均能转复为窦性心律。随访１９～４６（３１．６±７．１）月，２２例患者仍维持窦性心律（７３．３％）。房颤复发与患者的年龄、二狭程度无明显关系。房颤病程超过１２个月，ＰＢＭＶ后左房残留压较高和术后左房回缩程度小是房颤复发的重要影响因素。     

胺碘酮维持二尖瓣狭窄伴心房纤颤经皮二尖瓣球囊成形术后窦性心律的疗效

对二关瓣狭窄伴心房纤颤（简称二狭房颤）行经皮二尖瓣球囊成形术（PBMV）成功后的64例患者，术后即给予胺碘酮0．2g，3次／日×7天，未复律者给予经体表直流电复律，复律后随机分为胺碘酮0．4g／日维持量组和am0．2／日维持量组各32例。结果；单纯眼药1周转复窦性心律14例，余50例经直流电复律全部成功，复律后心功能均明显改善，随访21．60±12．3个目，16例心房纤颤复发。心房纤颤病程长，左房扩大明显者易复发，PBMV效果不佳（瓣口面积扩大程度小和左房四缩差）和术后再狭窄也是复发的重要因素，胺碘酮剂量小（0．2／日维持）易复发，故建议应用胺碘酮0．4／日维持。     

风湿性二尖瓣狭窄球囊成形术的临床应用

为了观察经皮球囊成形术（ＰＢＭＶ）对风湿性二尖瓣狭窄的临床疗效，对２９３例风湿性二尖瓣狭窄病人进行ＰＢＭＶ治疗。结果表明：（１）ＰＢＭＶ的成功率为９９％，术后即刻血流明显动力学明显改善，其中５２例外科术后再狭窄和４５例并存二尖瓣、主动脉瓣关闭不全的患者也获得了与原发性狭窄和单纯性狭窄相似的临床效果。（２）１０５例病人并发心房纤颤，１０３例ＰＢＭＶ成功，无１例发生栓塞并发症，术后１０２例接受复律治疗     

风湿性二尖瓣狭窄伴心房颤动球囊二尖瓣成形术后复…

报道９０例风湿性二尖瓣狭窄伴心房颤动（简称二狭房颤）患者球囊二尖瓣成形术（ＰＢＭＶ）和得律治疗的结果，并与同期行ＰＢＭＶ的１６０例风湿性二尖瓣狭窄无房颤（窦性民主律，简称二狭窦律）患者进行比较。结果表明临床上无血管栓塞并发症且经超声心动图检查无心房血栓的二狭房颤患者接受ＰＢＭＶ治疗与二狭窦律者一样具有良好的安全性和档效果。８９例二狭房颤患者ＰＢＭＶ后经复律治疗转为这生心律（其中１５例仅服用奎尼丁即     

心房纤颤的转律治疗

心房纤颤的转律治疗北京友谊医院（１０００５０）顾复生心房纤颤（房颤）是常见的心律失常，是否需要转复为窦性心律，常是心血管病医师面临的一个问题．心房收缩功能对血液动力学的影响很重要，在心室多张收缩前０．０８～０．１８ｓ，心房的收缩对增加心室舒张充盈量和...     

胺碘酮治疗快速心房纤颤的疗效观察

目的观察胺碘酮治疗快速心房纤颤的疗效及安全性。方法选取各种心脏病引起的快速心房纤颤患者68例,随机分为两组,在常规治疗基础上,治疗组（38例）加用胺碘酮静脉给药,对照组（30例）加用西地兰静脉注射给药,观察复律情况。结果胺碘酮在转复窦性心律方面与对照组比较差异有统计学意义。结论胺碘酮在转复快速心房纤颤方面效果显著,不良反应轻,是理想的治疗快速心房纤颤的药物选择。     

血浆脑钠肽在心房纤颤中的应用价值

目的探讨血浆脑钠肽在心房纤颤中的应用价值。方法选取2011年2月—2013年2月我院收治的心房纤颤患者580例作为治疗组,另选择同期我院收治的无器质性心脏病窦性心律患者190例作为对照组。测定复律前两组患者血浆脑钠肽水平,以及复律成功者复律前后血浆脑钠肽水平。结果复律前治疗组血浆脑钠肽水平高于对照组(P0.05)。治疗组复律成功者复律后血浆脑钠肽水平低于复律前(P0.05)。结论心房纤颤使血浆脑钠肽水平升高,复律后水平明显降低,血浆脑钠肽是心房纤颤复律效果预测的重要指标。     

Percutaneous transhepatic mitral commissurotomy

A novel, transhepatic approach to mitral valvuloplasty is described in a patient with an inferior vena caval filter. After transhepatic transseptal puncture, an Inoue dilatation catheter was passed through the hepatic parenchyma and across the atrial septum. Balloon mitral valvuloplasty was performed without complications. This approach should be considered when femoral venous access is restricted or is not feasible. © 1996 Wiley-Liss, Inc.     

分级次二尖瓣球囊扩张预防二尖瓣反流的初步研究

目的为探讨经皮穿刺球囊导管二尖瓣扩张术（ＰＢＭＶ）引起二尖瓣反流（ＭＲ）的原因及其预防方法。方法我们采用分级次扩张法和改良Ｉｎｏｎｅ法对人体病变二尖瓣和硅胶二尖瓣模型进行体外球囊导管扩张实验，并对１３２例风湿性心脏病重度二尖瓣狭窄患者，其中分别以分级次扩张法９６例，Ｉｎｏｎｅ法３６例进行ＰＢＭＶ的前瞻性对比研究。结果（１）ＰＢＭＶ引起二尖瓣反流的原因除与瓣膜钙化程度重、瓣下结构紊乱有关以外，瓣口面积小、交界粘连处夹角小是一个重要原因。（２）分级次扩张可使交界粘合处夹角呈渐进性扩大，扩张时不易引起瓣膜撕裂和二尖瓣反流。两组比较Ｉｎｏｎｅ法扩张组二尖瓣反流发生率为１６．７％，分级次扩张组无二尖瓣反流病例，并且术中其他并发症及术后再狭窄发生率后者也明显低于前者。结论球囊导管分级次扩张可有效地预防二尖瓣反流，是治疗二尖瓣狭窄较理想的方法。     

The echocardiographic association of mitral valve prolapse and mitral anulus calcification

Mitral anulus calcification (MAC) and mitral valve prolapse (MVP) are frequently diagnosed conditions. We studied two patients with mild or moderate mitral regurgitation who demonstrated both MAC and MVP on angiography and echocardiography. M-mode echocardiography is probably the definitive test for confirming the presence of MVP. Echocardiography is moderately sensitive in the diagnosis of cardiac calcification, such as MAC, but M-mode echocardiography may not detect the MAC in the majority of patients with both MVP and MAC demonstrated by angiography.     

外科二尖瓣交界分离术后再狭窄二尖瓣球囊成形术

将６６例二尖瓣狭窄患者首次行ＰＢＭＶ和１８例外科分离术后再狭窄患者行ＰＢＭＶ进行比较，结果表明两者扩瓣治疗前、后的血流动力学指数有明显差异（Ｐ＜０．００１），但将两者术后相应的血流动力学指数进行比较差异无显著性（Ｐ＞０．０５）。说明外科二狭分离术后再狭窄患者成功地进行ＰＢＭＶ可显著改善临床症状，仍是一种有效的方法。     

Parachute mitral valve with severe mitral regurgitation in an adult patient

Parachute mitral valve (PMV) is rarely seen in the adult population, in isolation or in association with other congenital heart defects, since most patients may have had milder lesions previously that were asymptomatic early in life, or were not detected due to lack of a comprehensive examination. We report a case of an 18-year-old woman with a history of exertional dyspnea, atypical chest pain, and cough for about 1 year. The echocardiographic examination identified a PMV with severe mitral regurgitation associated with bicuspid aortic valve and coarctation of the aorta. Most patients present with mitral stenosis of varying degree of severity, and rarely present with severe mitral regurgitation as seen in our patient.     

Pathology of mitral valve stenosis and pure mitral regurgitation—Part I

This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. In Part I, conditions producing mitral valve stenosis are reviewed. In over 99% of stenotic mitral valves, the etiology is rheumatic disease. Other rare causes of mitral stenosis include congenitally malformed valves, active infective endocarditis, massive annular calcium, and metabolic or enzymatic abnormalities. In Part II, conditions producing pure mitral regurgitation will be discussed. In contrast to the few causes of mitral stenosis, the causes of pure (no element of stenosis) mitral regurgitation are multiple. Some of the conditions producing pure regurgitation include floppy mitral valves, infective endocarditis, papillary muscle dysfunction, rheumatic disease, and ruptured chordae tendineae.     

Pathology of mitral valve stenosis and pure mitral regurgitation—Part II

This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. in Part I, conditions producing mitral valve stenosis were reviewed. in over 99% of stenotic mitral valves, the etiology is rheumatic disease. Other rare causes of mitral stenosis include congenitally malformed valves, active infective endocarditis, massive annular calcium, and metabolic or enzymatic abnormalities. in Part II, conditions producing pure mitral regurgitation are discussed. in contrast to the few causes of mitral stenosis, the causes of pure (no element of stenosis) mitral regurgitation are multiple. Some of the conditions producing pure regurgitation include floppy mitral valves, infective endocarditis, papillary muscle dysfunction, rheumatic disease, and ruptured chordae tendineae.